These are two very difficult questions for most older adults to answer realistically. The answers we usually hear are “home” and “my family.”  Great, honest answers, but they may not be realistic. For many reasons, the average single family style home located in the suburbs and built with steps, standard doorways, and inaccessible bathrooms may not be an ideal place to live out the final years.  And relying on adult children or other family members may not be sustainable or even plausible given distance, competing needs, and nonexistent or uninvolved family members.

 

Even though it may be unrealistic, many of us leave the answers as “home” and “my family.” We tend to foolishly believe that we have done enough planning for our future and that, more importantly, we won’t ever be someone that needs to make changes to our lifestyles or require any help.

 

Realistically answering the questions: “Where do you want to live?” and “How do you want to be cared for in your old age?” requires the ability to imagine that one day we may be frail, dependent, and/or disabled for a number of years.  We all seem to be overly optimistic about our aging selves. We deny that the realities of old age could apply to us. Nursing homes are for other people—the really sick and really old people, not me, not my spouse. We often hear, “There’s no way I would want to live in ‘an old folks’ home.” A quick, sudden death is what we all imagine will be our end, if we even allow ourselves to imagine our death.

 

Denying the possibility that one day we will need to be cared for by someone else or that our homes will not be the best match for our needs robs us of the opportunity to plan and have some actual control over our futures. We cannot control much of how we age—disease, disability, infirmity happen to us with little concern for our wishes, efforts, and strong wills; resisting this reality leaves us unable to plan well for its probable inevitability if we are lucky enough to reach old age.

 

Here are some examples of how we see this work scenario play out in our clients’ lives:

 

An 88-year-old woman who was recently diagnosed with mild cognitive impairment lived alone in her home. She is widowed, has one daughter, and wants to remain in her home of 51 years. She refused to move in with her daughter, and she would not even consider a personal care home because she didn’t want “to live around old people.”  Over the last few months, she was having a hard time keeping her medications straight, started isolating in her home, experienced increasing anxiety, and called 9-1-1 six times in three months. She eventually was hospitalized because of dehydration and suspicious blood in her stool, and from the hospital she went to a rehabilitation facility.  After she was discharged from rehab, her daughter moved her into an assisted living community.  The daughter began making most of the important decisions for her mom; she chose the assisted living community, decided to sell her mom’s house, and became the primary contact for all of her health care providers. Prior to this last hospitalization, her daughter had tried to get mom to make some proactive changes. She took her to several assisted living and independent living communities, set appointments with our office to discuss options and plans, and even hired an aging life care specialist. Despite these efforts, her mom refused to consider any changes; she canceled every appointment with our office, complained about every independent living community, and refused to meet with the aging life care specialist. She insisted that she was absolutely fine living in her home alone and that her daughter was just worrying too much. In the end, decisions were made for her instead of with her, and she lost the chance to choose for herself.

 

A 91-year-old veteran moved to an independent living community after his wife died. He lived there for 13 years but then started experiencing declining health and mobility issues due to nerve and back issues. He fell seven times in just three months, and his last fall resulted in a hospitalization and an inpatient rehab stay.  During this time, his primary care physician told him and his son that he could no longer live alone. It was too dangerous, and he needed 24/7 supervision. The son was not surprised—he had been trying to get his dad to look at the personal care home attached to his independent living community or to hire in-home caregivers. His dad refused to admit that his condition was changing and that he needed more care. In the end, his son facilitated a move for  him from the rehab community to a personal care home (not at his independent living community—they were full with a long waitlist) and reached out to Hurley Elder Care Law to help plan for the VA Aid and Attendance Benefit.  Contacting us at such a late time restricted how much asset protection planning we could do given the VA’s recent changes to the Aid and Attendance rules. The man is having a hard time adjusting to his new home, and his assets are being spent at a rapid rate on his care expenses. We know this could have ended up differently for them. He might have been able to stay at his community and close to the friends he had made over the last 13 years. He might have been able to qualify for the Aid and Attendance Benefit sooner and started receiving the $1,881/month benefit to help pay for his care. But this required him to be willing to engage in planning and thinking about his future care needs.

 

A 77-year-old woman lived alone in the same apartment for the last 41 years. She was a busy professional and kept mostly to herself.  Her landlord started getting complaints about her hoarding behaviors and messy apartment; he tried to evict her for hoarding years ago but her family stepped in to help her. Last year, she stopped paying her rent and stopped being seen around the community.  The landlord called Adult Protective Services (APS) and started the eviction process again. Help!  APS determined that she was a risk to herself due to self-neglect and an inability to make sound decisions or care for herself. She was malnourished, dehydrated, and unaware that she had put her housing in danger. She was sent to the hospital and then to rehab.  While she was in rehab, someone filed for guardianship and the judge named a professional guardian to oversee her affairs and make her decisions. She recovered well in rehab and then moved back into her apartment, but she is still a ward and is now fighting for her rights to be restored. Guardianship is an extreme example of what happens when a person fails to plan, but it is not rare.  It is estimated that there are over 1.5 million active open guardianship cases in the US. (You can read more about this woman by clicking here.)

 

The way we see it play out, by deciding not to plan ahead, have these difficult conversations, or even imagine the possibilities, you are relinquishing control of your future. By doing nothing, you are making a choice to let someone else decide for you one day.

 

So, where do you want to live if you cannot live in your own home? How do you want to be cared for? What is important to you? What do you fear? And what can you do today to be prepared for this possible future that requires care?